SAT-271 - Lipoprotein(A) Identifies A Distinct Non-Metabolic Cardiovascular Risk Phenotype in A Dominican Adult Cohort

Background

Lipoprotein(a) [Lp(a)] is genetically determined and an established independent risk factor for atherosclerotic cardiovascular disease. Unlike traditional lipid parameters, Lp(a) levels are largely unaffected by adiposity, insulin resistance, or glycemic status. Emerging evidence suggests inverse or null associations between elevated Lp(a) and markers of metabolic dysfunction, including metabolic-associated steatotic liver disease (MASLD), but data from Caribbean and Latin American populations remain limited. The aim of this study is to characterize the relationship between Lp(a) and adiposity, insulin resistance, glycemic status, and MASLD in a Dominican adult cohort.

Methods

A single-center, retrospective observational study was conducted using electronic medical records from an outpatient endocrinology clinic in Santo Domingo, Dominican Republic. Adult patients seen between 2024 and 2025 with available lipoprotein(a) measurements were identified. Lp(a) was analyzed as a continuous variable after log-transformation. Multivariable linear regression models evaluated associations between log-transformed Lp(a) and BMI, log-transformed HOMA-IR, HbA1c, and fasting plasma glucose, adjusting for age, and sex, and additionally for lipid-lowering therapy. MASLD was analyzed as a binary outcome using multivariable logistic regression, with log-transformed Lp(a) as the primary predictor, adjusting for age, sex, BMI, HOMA-IR, and HbA1c.

Results

A total of 97 patients were included; the mean age was 44.4±15.3 years, 33 (34.0%) were male and 64 (66.0%) were female. Log-transformed Lp(a) was not significantly associated with BMI (β −1.00, p=0.11), insulin resistance (β −0.21, p=0.10), HbA1c (β −0.02, p=0.71), or fasting glucose (β 0.10, p=0.93) after multivariable adjustment. Additionally, log-transformed Lp(a) was not associated with MASLD in multivariable logistic regression (adjusted OR 0.76, 95% CI 0.38–1.50, p=0.43).

Conclusion

In this Dominican outpatient cohort, Lp(a) showed no association with adiposity, insulin resistance, glycemic status, or MASLD, supporting the concept that Lp(a)-related cardiovascular risk is largely independent of metabolic dysfunction. Major limitations included the retrospective single-center design, small sample size, and potential selection bias from an endocrinology clinic population. Larger, prospective studies are warranted to further investigate the metabolic implications of Lp(a) levels.

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